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Monday, 31 October 2016

EDI - Exchange , clearing house. ERA

Electronic Transaction Exchange

Various healthcare transactions can be submitted electronically to the Blue Cross clearinghouse in a system-to-system arrangement. Blue Cross does not charge a fee for electronic transactions; however, the trading partner is responsible for its own expenses incurred for sending and/or receiving electronic communications.

You can send your transactions to Blue Cross via indirect submission through a clearinghouse or through direct submission to the Blue Cross EDI Clearinghouse. For more information about system-to-system electronic transactions, please contact EDI at EDICH@ bcbsla.com or 225-291-4334.Administrative Representative

Blue Cross and Blue Shield of Louisiana now offers network providers the option to request inpatient and outpatient authorizations electronically through our iLinkBLUE Provider Suite. In 2016, network providers will be required to manage their behavioral health and/or Blue Advantage (as applicable) services electronically. It is necessary to have a designated Administrative Representative before you can access many of the new portals (including the authorizations portals) that are being added to iLinkBLUE.

The role of an administrative representative is to serve as the key person at your organization who will:
• Delegate electronic access to appropriate users.
• Ensure those appropriate users adhere to our guidelines.
• Only grant access to those employees who legitimately must have access in order to fulfill their job responsibilities.
• Promptly terminate employee access at such time as an employee changes roles or terminates employment with the organization.
If your facility does not have a designated administrative representative, please contact our Provider Relations department at provider.relations@bcbsla.com or 1-800-716-2299, option 4.Electronic Payment Register/Remittance Advice (HIPAA 835 Transaction)

Providers, who submit their claims electronically, can receive an electronic file containing their Weekly Provider Remittance Advice/Payment Register. Once downloaded at the provider’s office, the remittance file can be uploaded into an automated posting system, thus eliminating a number of manual procedures. The ERA is available Monday mornings, allowing providers to begin posting payments as soon as possible.

ERA specifications are available from Blue Cross at no cost to vendors and providers, but they do require programming changes by your practice management billing system vendor. Traditionally, there is an up-front fee from your vendor for programming. From that point, you may receive the Blue Cross weekly Remittance Advice/Payment Register at no charge. For more information, please contact Blue Cross EDI at EDICH@bcbsla.com or 225-291-4334.